What is the role of prophylaxis against fungal or yeast infections in patients with HIV infection?

Updated: Mar 09, 2021
  • Author: Justin R Hofmann, MD; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

According to current NIH guidelines, Cryptococcus neoformans and Candida infections do not warrant primary prophylaxis. [24]  In the case of Cryptococcus infection, primary prophylaxis has not been shown effective in Thailand. [42]  New WHO guidelines recommend cryptococcal antigen testing and preemptive therapy in antigen-positive patients with a CD4 count < 100 cells/uL in Africa and other areas of high prevalence. Prolonged suppressive therapy for Candida is not recommended owing to risk of resistance. However, if necessary because of frequent recurrence or severe disease, fluconazole 100 mg PO thrice weekly for thrush (BI recommendation), fluconazole 100-200 mg daily (esophagitis) (BI), or fluconazole 150 mg PO once weekly (vaginitis) (CII recommendation) are the first recommended drugs. [24]

Fortunately, aspergillosis and phycomycosis (mucormycosis) are rare in individuals infected with HIV. These infections should be considered in patients with invasive sinusitis and focal pulmonary lesions but do not warrant prophylaxis.

Travelers to malaria-prone areas should have malaria prophylaxis, and those who live in such areas should practice preventative measures, such as the use of treated mosquito netting.


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